Perhaps you’ve been using mouthwash religiously for years, but you’re pondering what’s the point. Or maybe you’re wondering if you should start using mouthwash.
The truth? Mouthwash might get rid of some of the bacteria that can lead to gum disease (periodontitis). But it isn’t a substitute for brushing your teeth.
That isn’t to say it can’t be a welcome addition to your oral health routine. As long as you choose the right mouthwash, and you use it correctly.
Keep reading to learn about the pros and cons of mouthwash, the different types and, most importantly, if it’s really necessary.
Bacterial plaque is the main cause of gingivitis (milder form of gum disease), periodontitis, and tooth decay (dental caries). Devices, such as your toothbrush, interdental brushes, or dental floss, all can remove plaque build-up. Yet, using these tools doesn’t always prevent gingivitis or periodontitis.
Why? It could be that you’re not using the devices accurately or you’re not able to get to certain tooth surfaces. Some people may have reduced dexterity, making it harder to control a toothbrush or interdental brush/floss.
Using an antibacterial mouthwash, alongside brushing, may reduce the build up of bacterial plaque. But it doesn’t flow under the gum line and has minimal effect on plaque that is already formed. Before you stock up on mouthwash, it’s important to consider the pros and cons.
Some studies suggest that extended daily use of mouthwashes containing alcohol might increase the risk of oral cancer. But this is a contested idea and the subject of much debate.
Not all mouthwashes are the same. When choosing a mouthwash, consider its active ingredients because different types are designed to address different problems. Let’s take a look at some popular mouth rinses to understand the differences.
Antibacterial mouth rinses may contain a variety of different antimicrobial agents. Active ingredients include chlorhexidine, essential oils (eucalyptus, and menthol), cetylpyridinium chloride or triclosan. Antimicrobial mouthwashes assist in the control of bacteria in the mouth. For this reason they are useful to reduce plaque build up on teeth and may also be effective for ulcers.
While antibacterial mouthwash targets the bacteria in your mouth, antiseptic mouthwash helps prevent the growth of bacteria, fungi, and viruses. Using an antiseptic mouth rinse can be helpful for tackling mouth ulcers, addressing infection and combating bad breath (halitosis).
One of the most widely used mouthwashes is Listerine, which contains a phenolic antiseptic agent. Studies have also shown that the phenolic compounds in Listerine may have anti-inflammatory effects, which can help with gingivitis.
Another common active ingredient is cetylpyridinium chloride, which is the active ingredient in many (if not all) of the Colgate mouthwashes. Specifically, cetylpyridinium chloride may prevent bacteria’s ability to mature, reducing the risk of gingivitis.
Studies show that chlorhexidine-containing mouthwash (in conjunction with daily brushing) is the most effective oral rinse for reducing plaque and gingivitis. This type of mouthwash is readily available but we generally only recommended it for short term use post-surgery. Its antiseptic properties help reduce bacteria when brushing is difficult. For instance, following oral surgery when stitches are present. Chlorhexidine mouthwash should be used as instructed and for a short term only.
The most common side effects of chlorhexidine mouthwash include teeth staining, increased calculus (tartar), and temporary taste alteration.
Hydrogen peroxide is an ‘oxygenating agent’ and is another common antiseptic rinse. Hydrogen peroxide on contact breaks down into something called ‘hydroxyl free radicals’, which are damaging to the cell walls of bacteria and can also have a stain removal effect. Hydrogen peroxide is often present in tooth-whitening mouthwashes, which have grown in popularity but we find these are of limited value on their own for whitening teeth.
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Fluoride-containing mouthwash is generally recommended to help prevent tooth decay. Fluoride helps to remineralise the teeth and strengthen the tooth enamel to prevent cavities. This type of mouthwash is often recommended for people at risk of tooth decay. This includes people with dry mouth and those who have difficulty with regular oral hygiene.
Alternatively, if you have a high risk of tooth decay, you can make a simple at-home mouth rinse using bicarb soda. Simply mix one teaspoon of bicarbonate of soda into a cup of warm water and rinse after meals. This helps to reduce any acidity that makes teeth more prone to dental decay/caries.
People with dry mouth (xerostomia) can take steps to ease symptoms. This may involve a mouthwash recommended for dry mouth, such as Oral7 or Biotene. These improve mouth comfort for speech and chewing while also reducing risk of tooth decay. They contain enzymes that improve oral hydration, have some antimicrobial activity and reduce oral acidity.
People who wish to avoid alcohol and other chemical ingredients may choose a natural mouthwash. Most natural mouth rinses use the antibacterial, antiseptic, and anti-inflammatory (plus breath freshening) properties of essential oils. Commonly used oils include eucalyptus, tea-tree, peppermint, clove, and spearmint. Interestingly, eucalyptol is one of the active ingredients in Listerine.
If you simply want to avoid alcohol, most commercial brands have an alcohol-free variant.
Salt water mouthwash is a commonly used homemade mouthwash. Simply mix half a teaspoon of salt into lukewarm water and rinse. Dentists may recommend this after tooth extractions, but the scientific basis for its use is extremely limited and we’re not aware of any evidence to support its use for preventing gum disease.
The European Federation of Periodontology Guidelines do not support the routine use of mouthwashes. That is because the evidence that supports their effectiveness to help treat gum disease is very weak. At EOPerio, we don’t routinely recommend mouthwash either. But we don’t actively discourage people from using it if they want to and like using mouthwash.
The thing is, there is no substitute for regular and accurate/skilled use of a toothbrush and interproximal brushes for removing plaque and preventing gum disease. Toothbrushing and interproximal (between the teeth) brushing, if used accurately and regularly, will prevent gum disease in almost any instance. By comparison, mouthrinse doesn’t even come close. Yet, there are instances where mouthrinses may be appropriate—such as after tooth extractions/oral surgery or for people with a dry mouth and those who have a higher risk of tooth decay.
Mouthwash isn’t a substitute for regular brushing, and it won’t cure gum disease. But, for some people it may be a helpful addition to their daily oral hygiene routine.
The best way to know for sure if mouthwash is necessary and the best one for you, is to talk to your dentist or periodontist. Particularly if you have gum disease, it’s important to get the best preventative care advice for your individual needs.